Individual
MRS. TARA RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
17705 HUTCHINS DR, MINNETONKA, MN 55345-4145
(952) 401-8252
(952) 401-8286
Mailing address
6100 W 101ST ST, BLOOMINGTON, MN 55438-1816
(612) 790-1297
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
9228
MN
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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